INCIDENCE OF ANEURYSM FORMATION AFTER DACRON PATCH AORTOPLASTY REPAIRFOR COARCTATION OF THE AORTA - LONG-TERM RESULTS AND ASSESSMENT UTILIZING MAGNETIC-RESONANCE ANGIOGRAPHY WITH 3-DIMENSIONAL SURFACE RENDERING

Objectives. Magnetic resonance angiography with three-dimensional surf ace rendering was performed to determine its value in assessing anatom ic detail in patients with suspected aortic aneurysms. Background. Dac ron patch aortoplasty repair of coarctation of the aorta carries an in herent risk of aneurysm development. Sudden death from aortic rupture prompted discontinuing this operation and evaluating 39 patients (16 g irls; mean age 6.3 years, range 10 days to 14.5 years) undergoing repa ir between January 1976 and October 1987. The aorta ruptured in 10 pat ients; 6 died at a mean interval of 8.1 years (range 0.75 to 12.4) aft er repair. All 33 survivors were inter-viewed and examined. Methods. C onventional magnetic resonance imaging was performed in 26 patients, m agnetic resonance angiography in 18. Angiographic slices were used to reconstruct three-dimensional images. No catheterization or contrast a ngiography was performed. Surgical intervention was based on clinical findings and magnetic resonance images. Results. Twenty patients (II g irls) developed aneurysms, of which nine were detected in patients stu died by magnetic resonance. Ruptures occurred in eight female patients , three of whom were pregnant. Surface renderings accurately defined a ortic anatomy or aneurysms in all patients. On follow up, no aneurysms have been detected in patients with negative magnetic resonance study results. Precise anatomic correlation with operative findings was rep orted. Conclusions. Magnetic resonance angiography with three-dimensio nal surface rendering provides noninvasive, radiation-free and contras t agent-free high resolution images of the thoracic aorta These images can be reviewed and have three dimensional form and perspective. Thes e techniques were preferred over invasive angiography by surgeons and clinicians as definitive, risk-free procedures before surgical interve ntion.